We are committed to working with you to improve the quality of care and health outcomes for our members, your patients. HEDIS® (Healthcare Effectiveness Data and Information Set) is one tool we use to measure many aspects of performance. This document details some of the key features of the HEDIS measure for colorectal cancer screening.

What is the measure?

This measure focuses on members ages 50 to 75 who had appropriate screening for colorectal cancer. Appropriate screenings are defined by one of the following:

• Fecal occult blood test (FOBT) during the measurement year

• Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year

• Colonoscopy during the measurement year or the nine prior years

• Computerized tomography (CT) colonography during the measurement year or the four prior years

• Fecal immunochemical test (FIT)-DNA (Cologuard®) test during the measurement year or the two prior years

Alternatives to colonoscopy and the difference between the tests:

Guaiac-based Fecal Occult Blood Test (gFOBT)

• Test that checks for blood in the stool

• It is done at home using a kit given to patient

• Need to avoid certain foods and medicines for a few days before the test

• Requires three separate bowel movement samples placed on a card

Frequency: Annual

Fecal Immunochemical Test (FIT)

• Test that checks for blood in the stool

• It is done at home using a kit given to patient

• No diet change needed

• Only one bowel movement sample needed per card or in vial

Frequency: Annual

FIT DNA Test (Cologuard®)

• Test that checks stool for blood and abnormal DNA from polyps or cancer

• It is done at home using a kit shipped to the patient’s home

• No diet change or prep needed

• Bowel movement is collected into a container and a small sample of that stool is put in a sample vial

• Kit comes with instructions for how to mail the bowel movement and stool sample to the lab

Frequency: Every three years

Unacceptable forms of documentation are:

• A digital rectal exam (DRE) does not count as evidence of a colorectal cancer screening because it is not specific enough to screen for colorectal cancer.

• FOBTs performed in an office setting or performed on a sample collected via DRE do not meet criteria.

Exclusions:

Any of the following, any time during the member’s history through December 31 of the measurement year, are exclusions for this measure:

• Colorectal cancer

• Total colectomy

• Hospice care during the measurement year

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gaps in care (GIC) reports and detail summaries, research member attribution issues, and provide overall HEDIS support to you and your practice. Our QCT nurses can be reached at QualityHEDIS@bcbsri.org or at (401) 459-1005.